On average, in-flight medical emergencies occur about 15 times per day. When asked by flight crews to help in a medical emergency, providers have fairly extensive legal protection, and in some cases have a legal obligation to help [1]. In the U.S., all 50 states have some form of a “good Samaritan” law, which provides legal protection to medical providers who perform their services in response to medical emergencies outside the hospital. While these laws typically apply broadly to most out of hospital emergencies, in 1998 Congress specifically passed the Aviation Medical Assistance Act (AMAA) which offers legal protection to providers, who give assistance in the case of an in-flight emergency [2].

1. You should help if asked.

From an ethical standpoint, providers have an obligation to provide assistance when possible. In terms of in-flight emergencies, two conditions need to be met in order for the provider to be considered a volunteer under the AMAA.

The flight crew must ask for assistance. Responding to an overhead page of “Is there a doctor on board” meets this qualification. Providers who respond to an emergency without being asked to do so by the airline are covered under the AMAA, but are not typically protected by the airline.

The flight crew must make an effort to determine if the provider is a “medically qualified individual.” The AMAA defines “medically qualified individuals” as anyone who is licensed or otherwise qualified to provide assistance including physicians, nurses, physician’s assistants, and paramedics. The flight crew is asked to make a good-faith effort to verify credentials, which can include asking for proof of licensure. Airline policy will dictate what type of proof is required. Providing this documentation does not mean that you are acting in a formal medical capacity and does not compromise legal protections that are provided for volunteer responders [3].

2. You may be required to help.

The AMAA covers airlines that are registered in the U.S. Airlines registered in other countries may have broader coverage for providers. For example, airlines registered in the European Union and Australia go beyond providing protection and include a legal obligation for physicians to respond to in-flight emergencies. Generally the laws from an airline’s home country apply while in flight.

3. You are protected if you help.

Typical medical malpractice cases refer to the concept of simple negligence, which means that a provider’s actions departed from good and accepted medical practice. This is typically known as a deviation from a particular standard of care. The AMAA offers broad legal coverage to providers that respond to in-flight emergencies and protects them from instances of simple negligence. When responding to in-flight emergencies, providers are not held to any particular standards and are simply expected to avoid gross negligence and willful misconduct which refers to a “conscious voluntary act or omission in reckless disregard of a legal duty and of the consequences to another party.” [4]

For example, if you are asked to perform a vaginal birth delivery on a flight to Hawaii, you are expected to make your best attempt to treat the patient, but you are not held to the same standard that you would be if the same situation occurred in your Emergency Department.

4. You can be thanked for your services.

In general, providers should not ask for financial compensation or submit a bill for their services; however, accepting a gift such as an upgraded seat in business class or even a voucher for a free flight should not compromise their legal protection.

5. You don’t determine the ultimate disposition.

Most airlines partner with a health care agency that provides on-line medical assistance. When responding to an in-flight emergency, providers should work in conjunction with the airlines medical team. Decisions such as the need to divert the plane are complex as they involve logistics, which includes weather, fuel supply, and availability of a suitable landing area. A recent study of about 15,000 in-flight emergencies found that the aircraft was diverted in only 7% of the cases. In the event of a critically ill patient, providers should provide their best medical opinion in terms of need for immediate care, but ultimately the decision to divert the plane lies with the pilot and the airline [5].

Bottom Line

As the rate of air travel increases, emergency medical providers are increasingly likely to encounter an in-flight emergency. Providers have extensive legal protection when helping with these cases and should not hesitate to offer assistance when they are able.

References

Stewart PH, Agin WS, Douglas SP. What does the law say to Good Samaritans?: A review of Good Samaritan statutes in 50 states and on US airlines. Chest. 2013;143 (6): 1774-83. PMID 23732588

(b) compensation – varies hugley. Have spent 5 mins with a ‘faint’ and been rewarded with an upfrade…but also spent six hours with an unwell patient in difficukt circumstances and not only missed connecting flight as last to leave…but also not a word of thanks.

Given the frequency of such occurrences, would it not be sensible to ensure airlines stocked decent kit and pehaps travellng meicos could be identified as available/not available at checkin, ensuring responder is sober and rewarded for offeringthis service if needed

Matthew

-The equipment is really variable, generally the larger the plane, the larger the kit. Some of the big international airlines have pretty extensive kits.
-I have a friend who identifies himself as a doctor when he checks in. Apparently one time they offered to upgrade him if he would be on “standby”. I think this is where it gets a little tricky as some legal folks would argue that if you offer your services you may jepordize your status as a “volunteer” responder.

njoshi8

This is fascinating – I did not know that is a legal obligation in some countries – good to know for international travelers!

Maria Romanas

I am a pathologist. I live in fear of that announcement. It has been 17 years since I’ve dealt with an emergency patient or touched a patient in any way other than to do a biopsy.

RN

I was on a flight from India to Paris when a call for a doctor was made. I told the flight attendant that I was a nurse. but would help if needed. She came back later and said there were no doctors on the flight (it was full, I found that hard to believe). I spent several hours with a women who spoke more English than I did French. I thought she might have pneumonia with her labored breathing and fever, and asked for oxygen, while restating that I was not a doctor, but I thought she needed it. When the doctor met us on the plane in Paris, that’s what he thought, too. Whew! I was offered a bottle of champagne as thanks, but I was afraid that would constitute payment, so I declined. Glad to know now that would have been ok.

GRINGO DOC

similar incident

GRINGO DOC

doctor call came. Man had passed out at restroom. F/A asked to see my license. I went to see patient and explained my license is in attache’ case and time is critical. I said I would show it on deplaning. She insisted it is “company policy.” I proceeded to see patient anyway and sat next to him until landed and paramedics took him off plane. I showed license. Never got a call or letter until a month later I inquired as to my good deed going unnoticed. Airline did sent note as well as a travel voucher.

Holly b.

This is an excellent topic. I didn’t understand the international laws before. I was once on a plane from Australia, when that dreaded announcement was made on a 747. I waited a bit, as I already had a couple of drinks, but then rang my buzzer . I did tell the attendant that I had consumed alcohol l but fortunately the case was a tick removal from the back of a young man, that was easy. My last flight to New Zealand, on New Zealand air, there were 2 medical assessments, actually in my row and the one behind, but according to a nurse that responded, he said that that airline doesn’t make an announcement, but if you are a medical professional you can tell them ahead of time which he did. The old, probably septic man next to me was then asked to leave the plane prior to our departure. I would feel if you volunteer yourself on “standby”, then you would be obligated not to drink.

Ambulance Science

I have been a paramedic for 28 years, fly ~30 times a year, and I think they would have better success getting the right people to volunteer if they asked for “an emergency medical professional” rather than “a doctor”. Don’t ignore my profession then expect me to volunteer to help, because that probably isn’t going to happen. So I let the pathologist or podiatrist care for the syncope, because, well, they’re “doctors” while keeping an eye on things-if the patient was really going down the tubes, I would probably grudgingly help, but only because that doctor was nice enough to volunteer and I would feel bad for them.

Matthew DeLaney

The AMAA, which offers providers legal protection clearly uses a broad definition of provider to include medics and nurses, it is a shame if people who can actually offer help are overlooked in favor of doctors who may have very little interest or experience in taking care of an emergency.

Carol

I’m sure any doc would appreciate it if you would jump in. I know I would. I work in a rural community and the paramedics are top notch.

Ambulance Science

I have never had a bad experience with physicians, probably in part because I worked mostly for hospital-based medic systems (NJ and NYC) where our boss was also the ED Director and we were both treated as, and expected to perform as, medical professionals. My problem is with a public which loves us only when they need us and ignores/demeans/refuses to fund us the other 99% of the time.

Carol

It’s good to know we have protection. I’ll be sure to pack my credentials.

Oliver Hawks

Mid Atlantic asked to see mid thirties triathlete with history of previous spontaneous pneumothorax x2 treated with pleurodesis who c/o sudden onset pleuritic left sided chest pain and shortness of breath with plane climbing to altitude. He had put up with it for a few hours before informing the attendant.

Assessed as borderline tachycardia and increased resp rate. Auscultation useless. Whilst waiting for medical control to come online I gave high dose NSAIDs from my carry on. US based control advised high dose aspirin, nitrates ? ACS. By this time (45mins later) patient had improved significantly with analgesia and whilst uncomfortable was not in extremis.

This raised a difficult point for me as I disagreed with diagnosis and management. Who is responsible for the patient legally. Am I or is the remote advice service?

(UK based airline, I am UK registered, patient UK citizen) I discussed with patient, their wife and the airline captain that I would allow the remote treatment although I disagreed with their diagnosis. In the event of worsening physiology we agreed a course of action including cabin altitude alteration and decompression of the chest and that I would take responsibility as the treating doctor. All rather difficult!

Hecqs

Had a chance to open the emergency kit of United flight to Los Angeles. Yes, after confirming my identity and being an MD. Patient was an elderly and was having vasovagal response to her abdominal pain (or maybe hypoglycemia, too). She was on the middle seat just after the first class cabin. Laid her down to the floor and saw a glucose sachet in the kit and gave it to her as well. She started to get warm and feel better. My finger on her radial pulse all through the rest of the flight. The flight attendant asked me if we need to divert the flight, as the captain was asking. I told him, we will be starting descent in 15-30 minutes and another 30 minutes we will be on the ground, so I told him to tell the captain to ask for priority to land and for EMS planes side. I sat on the floor with the patient lying on the floor until we landed. Attendant after sometime finally allowed me to just sit on the floor during landing. EMS finally got her after landing. I then left the scene just giving me my name and Frequent Flyer number. I then got a letter from United and 25000 bonus miles. After that, I went to CVS pharmacy and bought a portable pulse oxymeter for me to keep with me when traveling.

Another GringoDoc

While a medical resident in the late 70’s I was returning home flying on an international charter. The cigarette smoke was so thick that I could barely see my seatmate. I was counting the seconds until this ordeal would end.

Then the call came: “Is there a doctor in the house”?

I quickly volunteered. The passenger was experiencing acute angina. The pilot personally came back and said “What can I do? Divert the plane? Anything else?”

I said “Don’t divert but have a rig meet us on the tarmac. Oh, and drop the oxygen mask and TURN ON THE NO-SMOKING sign for the remainder of the flight!!!

Both the passenger and his new physician survived!

Doc

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